Integration, implementation. · 2017-08-08 · Integration, implementation. ‘Implegration ......

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Tony Ward Pamela Yates

�Context: Why are we here?� Integration, implementation.

‘Implegration’�Assessment Session� Treatment and beyond

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� Strengths-based, positive approach� Collaborative, motivational approach� Focuses on how treatment will benefit

client / what client will gain from treatment

� Two goals:› Reducing/managing risk› Attaining fulfilling life, psychological well-

being

� GLM integrated with RNR

Primary Good → Common Life Goal

Life → Life: Living and SurvivingKnowledge → Knowledge: Learning and KnowingExcellence in Work & Play → Being Good at Work & PlayExcellence in Agency → Personal Choice and IndependenceInner Peace → Peace of MindFriendship/Relatedness → Relationships and FriendshipsCommunity → Community: Being Part of a GroupSpirituality → Spirituality: Having Meaning in LifeHappiness → HappinessCreativity → Creativity

� GLM proposes that offending, life problems result from flaws implementing good life plan

� Four types of flaws: › Means › Lack of scope › Conflict among goods/means› Lack of capacity (internal and external)

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52%

30%

Which three theories best describe your

treatment approach?

GLM responses, adult male programs

Geographic Distribution of Programs (N = 13)

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� Greater attention to approach (vs. avoidant) goals, individual focus, holistic focus

� GLM approach embraced by clients and program staff

� But…many programs integrated GLM only at end of program (e.g., final module)

• Implementation:

› “to put into effect according to orby means of a definite plan or procedure.”

› In treatment, refers to implementing a model or approach with fidelity

• Usually top-down training and consult

• Integration:

› “to bring together or incorporate (parts) into a whole”

› “Our program uses the GLM, is informed by the GLM, etc.”

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• Implegration (Carl Åke Farbring)

• The process of implementation and integration

• Using internal expertise to assist in implementation.

� Including unique approaches to learning

Implementation:

• Top-down training and consult:

� Can alienate staff

� Benefits can disappear with staff turnover

� Involves unlearning old habits as well as new

� Does not always result in actual change of behavior at the front lines (Farbring, 2011)

• Integration:

› “Our program uses the GLM, is informed by the GLM, etc.” is not necessarily faithful to the model or its guiding principles.

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• Bottom-up perspective

• Balance between guidelines and mindlines

• Exploring-and-listening attitude

• Local ownership

• Adjusting implementation to local conditions

• Positive support trumps monitoring and control

› After motivational interviewing training:

• Two agencies sought to have trainer come back to observe and re-train in order to “keep the spirit alive”

• Two agencies set up the “MI Tip of the Week”

• Two agencies grew their own internal trainers

• Numerous practitioners selected specific skills to practice that week.

• No agencies have taken an advantage of an offer of a free post-training consult

Successful GLM implementation may rely as much on subtracting old practices (cycle work and avoidance based goals and tasks) as on adding new ones (e.g., approach goals)

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� RNR-based assessment › Includes static/dynamic risk and specific

responsivity factors (e.g., developmental disability, mental health, substance abuse, etc.)

� Identification of valued common life goals and goals implicated in offending

� Assessment of each common life goal› Includes weighting, past and current means used

to attain goal, problems attaining goal

� Identification of GLP flaws

E.g., Willis, Yates, Gannon, & Ward (2013); Yates, Prescott, & Ward (2010)

� Structured clinical exercise (formal assessment tool available; Yates et al., 2009)

� Determine those things (i.e., activities, situations, experiences) that are important to the individual in his or her life› Infer common life goals

� Detect goals evident in offense-related actions and general life functioning› Infer common life goals implicated in

offending (presence or absence) – what was client trying to gain?

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� 30-year-old male, East Indian decent� Index offending = sexual penetration

of a child under 16 years� Victim = 12-year-old sister-in-law� Prior convictions for common assault,

producing false documents� Static-99R: moderate-high

o Identify Common Life Goals valued overallo Identify Common Life Goals implicated in

offending o Identify Good Life Plan flawso Identify dynamic risk factors

o Optional: Identify Self-Regulation pathway(Avoidant passive, avoidant active, approach automatic, approach explicit)

� Common life goals important to Rakesh:

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� Common life goals implicated in Rakesh’s offending:

� Common Life Goals Important to Rakesh:

› Relationships› Spirituality› Community› Personal Choice and

Independence› Life

� Common Life Goals Implicated in Offending:

› Relationships› Peace of Mind› Happiness/pleasure› Knowledge (absent)

� Flaws in Good Life Plan:

� Dynamic Risk Factors:

� Informed by case formulation› Relationship between offending, dynamic risk

factors, self-regulation, pursuit of common life goals

� Intervention plans provide roadmap for working toward dual aims of treatment› Enhanced well-being, reduced risk

� Intervention plans form basis of future-oriented good life plans› Dynamic, refined as treatment progresses,

clients build strengths, develop skills to achieve common life goals in pro-social ways

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� Intervention planning = collaborative› Therapist links client goals with treatment targets

(criminogenic needs)

� Individualized plans constructed for each client › Revolve around goal attainment, risk reduction› Set out valued common life goals, how clients plan

to attain them › Attend to internal and external conditions

necessary to attain goals› Target dynamic risk factors to address risk

E.g., Willis et al. (2013); Yates et al. (2010)

Rakesh’s Goals Associated Treatment Goals/Targets

- Never get in trouble with the law again

- Develop understanding of offense process

- Improve relationships with brother and father

- Enhance relationship/intimacy skills; understand impact of behavior on others- Develop appropriate means for securing intimacy

- Be physically and mentally strong

- Develop effective emotion regulation, problem-solving skills- Develop appropriate means for securing peace of mind

- Practice my religion - Assist/encourage with connection to Hindu community and activities

� Introduction to treatment› Concept of common life goals

› Attaining common life goals (secondary/instrumental goods)

› Flaws/problems attaining common life goals

› Introduce notion of links between common life goals, flaws, offending, risk factors – maze analogy

› Concept of good life plan (their roadmap)

� Group rules/guidelines› Developed collaboratively, approach-goal oriented,

linked to dual aims of treatment

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� 10-phase model of background factors and offense progression

� Used for relevant personal history (“autobiography”) and understanding offending (“offense chain”) exercises

� Four pathways to offending:› Avoidant-Passive› Avoidant-Active› Approach-Automatic› Approach-Explicit

� Relevant personal history› Good life plan(s)

� Valued common life goals, associated secondary goods

� Problems attaining common life goals

� Early risk factors/predispositions to offend

� NOT “autobiography”

› Purpose: � Examine strengths

� Examine/confirm GL goals

� Examine/confirm risk factors

� Facilitate comfort with disclosure in treatment

� Obtain feedback from other participants on above

� Understanding offense process› Understand role of common life goals,

secondary goods (means), flaws› Determine common life goals at all stages of

offense process› Focus = what individual was trying to gain

� Did pre-offense behavior and offending represent opportunities to meet, keep, or re-acquire common life goals?

� After offending, were goals achieved?

� How does offense fit into good life plan?

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�Treatment intensity and targets based on risk and criminogenic needs

�Goals of each component framed using approach (rather than avoidant) goals

�Program components linked to fulfilment of common life goals

Autobiography

Offense Progression

Cognition/Problem-Solving

Relationships/Intimacy Deficits

Sexual Self-Regulation

General Self-Regulation

Emotion Regulation

Relapse Prevention Plan

→ Good Life Plan (past and present)

→ Knowledge, Good Life Plan (past and present)

→ Knowledge, Personal Choice & Independence, Peace of Mind, Relationships & Friendships

→ Relationships & Friendships, Community

→ Happiness, Peace of Mind, Relationships & Friendships, ++

→ Peace of Mind, Personal Choice & Independence, ++

→ Peace of Mind, Personal Choice & Independence, ++

→ Integrated Good Lives and Risk Management Plan (present and future-oriented)

� Includes all goods important to individual› Sufficient scope

� Includes non-offending, practical ways to attain goods/goals› Consider environment in which client will be living

� Identifies threats/obstacles to goods attainment and strategies for managing

� Includes risk management plan› Strategies to manage dynamic risk factors› Strategies to attain a better life

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How I will meet this goal How I and others will know I am meeting

this goal

Live with my brother; weekly phone calls to parents in India; make new friends through religious and cultural activities.

They will see me spending time with these people. They will see my open communication with family in good and bad times.

Obstacles I will need

to manage (incl. risk factors)

Warning signs for risk

(how I and others will know)

How I will use self-regulation

skills and strategies

Past tendency to withdraw from family when I feel like I can’t cope; trying to find intimacy or a relationship in the wrong places.

Physical and emotional withdrawal from family, friends, and cultural activities; befriending and feeling attracted to underage girls.

Recognize in advance when I am at risk of withdrawing, e.g., at times of stress. Remind myself that showing emotion is healthy and not a sign of weakness. Identify inappropriate sexual thoughts and implement strategies to keep myself and others safe.


this goal

Daily meditation, including yoga. Using problem-solving skills in everyday life, not using alcohol or drugs.

They will see that I have a positive outlook on life and feel at ease within myself, appearing calm and relaxed without the need for alcohol or drugs.

Obstacles I will

need to manage (incl. risk factors)

Warning signs for

risk (how I and others will know)

How I will use self-regulation skills

and strategies

Situations of stress or frustration and use of poor coping strategies to manage stress (alcohol, drugs, sex, pornography).

Heavy drinking, taking drugs, pornography use.

Ensure open communication with family especially when stressed; seek support from family and professionals; limit time spent at bars/nightclubs; employ emotion regulation and problem-solving strategies. This can include physical activities as well as stepping back and using thinking skills.

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this goal

Complete my degree and develop a business plan.

Attendance at university, high grades.

Obstacles I will


Warning signs for

risk (how I and others will know)

How I will use self-regulation skills

and strategies

Conflict in my life, especially associating with bad company, and returning to old ways including heavy drinking

Associating with negative peer influences, heavy drinking.

Join a cultural or religious group at university to help develop a new, pro-social group of friends. Employ emotion regulation and problem-solving skills as needed.


this goal

Participate in maintenance program; advanced courses in Indian history and traditional medicine.

Regular attendance at maintenance program, enrollment in educational courses.

Obstacles I will






Conflict in my life, especially associating with bad company, and returning to old ways including unhealthy sexual fantasies and preoccupation.

Associating with negative peer influences, heavy drinking, not attending maintenance group and courses. Not actively valuing cultural heritage and continuing study of my cultural heritage.

Maintain regular contact with cultural/religious groups at university; continue study of Ayurvedic medicine and yoga; employ problem-solving skills to resolve conflict.


this goal

Routine prayers, going to temple.

Regular attendance at temple.

Obstacles I will






Conflict in my life, especially associating with bad company, and returning to old ways including heavy drinking.

Associating with negative peer influences, heavy drinking, not attending temple.

Employ problem-solving skills to resolve conflict.

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this goal

Join a gym. Going to the gym three times per week, increasing physical strength and fitness.

Obstacles I will






Associating with bad company, heavy drinking, low motivation, financial strain.

Associating with negative peer influences, heavy drinking, not going to the gym.

Employ problem-solving skills, reassess goal and revise if necessary (e.g., jog three times per week instead of going to the gym).


this goal

Going to temple, meeting other people interested in Indian history through education courses.

Going to temple at least weekly, feeling like I belong.

Obstacles I will






Conflict in my life, especially associating with bad company, and returning to old ways including heavy drinking.

Associating with negative peer influences, heavy drinking, withdrawing from community activities.

Employ problem-solving skills to resolve conflict.


this goal

Actively take pleasure in accomplishments as they happen. E.g., education and business plan completion. Express gratitude routinely to people who help me.

Organizing milestone events such as graduation parties; writing letters of gratitude on an on-going basis to people who help me.

Obstacles I will






Stressful situations that make me focus exclusively on what’s wrong and not what’s right.

Rumination on negative thoughts/feelings; alcohol and pornography use.

Journal what goes well each day; tell one family member something that goes well on a weekly basis. Recognize when I am ruminating, use thinking skills.

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this goal

Making my own way in life by setting and achieving the goals in this plan.

Feeling a sense of accomplishment from achieving goals I have set for myself andhaving a balanced life.

Obstacles I will






Impulsivity, abandoning my goals and returning to my past lifestyle (bad company, alcohol, drugs, pornography

All of the above; also low motivation, pessimism about my future.

All of the above; also review this plan regularly with family and professionals, monitor progress, update plans as needed, reward accomplishments.

Willis, G. M., Yates, P. M., Gannon, T. A., & Ward, T. (2013). How to integrate the Good Lives Model into treatment programs for sexual offending: An introduction and overview. Sexual Abuse: A Journal of Research & Treatment, 25, 123-142.

Yates, P. M., Kingston, D. A., & Ward, T. (2009). The Self-Regulation

Model of the offence and re-offence process: A guide to

assessment and treatment planning using the integrated Good Lives / Self-Regulation Model of sexual offending. Victoria, BC: Pacific Psychological Assessment Corporation.

Yates, P. M., & Prescott, D. S. (2011). Building a better life: A good lives and self-regulation workbook. Brandon, VT: Safer Society Press.

Yates, P. M., Prescott, D. S., & Ward, T. (2010). Applying the Good

Lives and Self Regulation Models to sex offender treatment: a practical guide for clinicians. Brandon, VT: Safer Society Press.

[email protected]@auckland.ac.nz

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Integration, implementation. · 2017-08-08 · Integration, implementation. ‘Implegration ......

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